95 and Navigating Medicare in Florida

Amanda Anderson, RN, BSN is a Center for Health, Media & Policy Graduate Fellow.

A recent update from the Kaiser Family Foundation brought fresh news of Florida’s health care landscape; a land far from our chilly New York temperatures, but close to my heart just the same. Florida, you see, is where my 95-year-old grandmother goes to escape harsh Buffalo winters. This year, after selling our upstate childhood home in a quest for change, my parents are also spending the winter in the sun, living with my grandmother and her husband. In their transition, mom and dad are helping Far Mor, the woman I’ve always known by this Swedish nickname; she is growing frail, and we’re all wondering if this will be her last season in the sunshine state.

Last week, my mother told me that she took the nonagenarians to the Area Agency on Aging (AAA), because, “Far Mor got a letter in the mail, and her insurance will go from zero dollars a month to four hundred with Obamacare.” My reading told me that Florida is one of the most hostile states towards the Affordable Care Act, limiting Medicaid expansion and refusing a state-run health exchange, but I knew that this shouldn’t affect my grandmother, exempt from the exchanges as a long-time Medicare recipient. So, with the December 7th open enrollment deadline quickly approaching, I thought I’d check in to see what was up.

My grandmother, a feisty little Swede, has been fortunate. With few health problems – a longstanding hearing deficit and some stubborn high cholesterol – she’s fared well on her recipe for longevity of vitamins, hard work and genetics, until last year, when she suffered a stroke that landed her in the hospital. More than $27,000 and a fistful of prescriptions later, she became conscious of the part her otherwise silent health insurance – Medicare Advantage – played.

“My bill was just one thousand dollars,” she said of her lengthy hospitalization last Christmas. Now, she tells her main concern: the money she is afraid she’ll have to pay for health insurance since WellCare, her current provider of Medicare Advantage, is consolidating her longstanding plan in preparation for January’s changes and costs, like many providers around the country. “I was soaring on cloud nine, no bills at all, for years and years,” she said, unaware that her $96 premium was taken directly from her social security check all along.

With this shakeup, she worries about the cost of a new prescription that would replace the Coumadin that she begrudgingly takes. She is a funny noncompliant patient, eating too many greens and vegetables that make her INR level (a blood test that measures how fast the blood clots) bounce inconsistently, like rain on the roof. With her blood-thinning medicine, she’ll be able to eat whatever she wants, but she feels troubled by the nuisance of having to pick another plan, especially with this new drug in her regimen.  Why change anything at all, when Medicare Advantage worked so well for so long? “I blame our president, of course,” Far Mor says, with Fox News blaring in the background.

Her confusion doesn’t seem to be a rarity amongst seniors. With the whirlwind of the health exchanges taking up the majority of media coverage, it’s easy to see how a routine yearly requirement – to stay or change Medicare plans – might lead to confusion in a population privy to consistency. I have seen my grandmother hunched over her dining room table amongst piles of bills, balancing her checkbook many times, but never perusing a download, or filtering Google search results. New terminology, dates, technology; some Medicare plans are even using the “gold” and “silver” of the ACA marketplace, adding to the complexity.

Talking to my mother is another story. A woman well versed in the intricacies of health insurance plans, learned from years spent maneuvering the policies of a four-child family, it is fortunate that she is there for her mother-in-law . “She couldn’t hear, and he forgets,” she says of their time with the volunteer at the AAA. Speaking of the complexity of reviewing and understanding the available plans on medicare.gov, my mother doesn’t know how my grandmother would have fared without her help. “Think of all the people who have no one to do this for them,” comes as a stark statement in a state where the government forbade federally funded navigators from entering state-run facilities.

A deeper look into the organization where my parents and grandparents sought assistance brings hope. The program that they received counsel from, called SHINE – Serving the Health Insurance Needs of Elders – is run by volunteers who provide unbiased counsel for elders needing to know their options with the changing market. My grandmother, perfectly happy on Medicare Advantage with WellCare, was told she’d be changed to a Medicare Original plan when her policy is eliminated this January. This plan, explained to her as the default plan, sports high out of pocket expense caps – a fact she had no idea, or understanding of – and could have landed her in a load of debt if she had fallen ill.

After reviewing the options, my mother says they will likely choose the HMO that Humana offers. With this, her cost will change marginally, but the great expense that my grandmother has incurred is that of education. Likening the process, which included a home visit from a Humana representative, to a “fire hydrant of information,” my mother reported that Far Mor felt overwhelmed by the change, although grateful that her new plan covers the Pradaxa, allowing her to eat as many greens as she likes.

“Only death and taxes do not change,” she laughed, a phrase I’ve heard her say many times before. This time, though, she sounded weary, as though the process and my questions tired her. I am so glad that my parents are there to shepherd her through this decision so that she can get the care she needs – and wants – for her final years. But what if they weren’t?   written by Amanda Anderson, RN, BSN

Amanda Anderson, RN, BSN is a Center